Social media, e-health and clinical practice:tips for clinicians,guidelines, and exploring pathological internet use

Main Article Content

Donald M. Hilty, MD Christopher S. Snowdy, MD Erica Z. Shoemaker, MD Yvette S.M. Gutierrez, BA Vladimir Carli, MD, PhD

Abstract

The patient-centered care features quality, affordable, and timely care in a variety of settings – technology is a key part of that – particularly among younger generations and child and adolescent patients. The consumer movement related to new technologies is nearly passing clinicians by, as new ways of communicating with others (text, e-mail, Twitter, Facebook) revolutionizes how we experience life and access healthcare. This paper explores a continuum with healthy, innovative behavior on one end (e.g., social media) and pathological Internet use on the other end – and the range of self-help and e-mental healthcare options being used.  Specifically, it focuses on how social media adds to, yet may complicate healthcare delivery, such that clinicians may need to adjust our approach to maintain therapeutic relationships, interpersonal/clinical boundaries, and privacy/confidentiality.  We suggest planning ahead to discuss expectations about online communication between doctors and patients as part of the informed consent process, offer other do’s and don'ts for patients and clinicians, and review applicable guidelines.  More research is needed on consumer and patient use of technology related to healthcare, as is an approach to basic and advanced measurement of outcomes.

Article Details

How to Cite
HILTY, MD, Donald M. et al. Social media, e-health and clinical practice:tips for clinicians,guidelines, and exploring pathological internet use. Medical Research Archives, [S.l.], v. 3, n. 7, mar. 2016. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/292>. Date accessed: 13 nov. 2024.
Keywords
Psychiatry; mental health; telemedicine; technology; health informatics; social media; Internet; web-based; pathological; patient-centered; empowerment
Section
Review Articles

References

American Medical Association. (2011). Opinion 9.124 - Professionalism in the Use of Social Media. AMA Code of Medical Ethics 2011. At: http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/opinion9124.page? Accessed May 30, 2015.

American Psychiatric Association Electronic Prescribing Guideline (2013). At: http://www.psychiatry.org/practice/managing-a-practice/electronic-prescribing/electronic-prescribing-. Accessed June 30, 2015.

American Psychiatric Association (2013). Diagnostic and Statistical Manual, Fifth Edition. Washington, DC: American Psychiatric Publishing, Incorporated.

Bakken, I. J., Wenzel, H. G., Gotestam, K. G., Johansson, A., Oren, A. (2009) Internet addiction among Norwegian adults: A stratified probability sample study. Scand J Psychol, 50(2):121-127.

Ball, C. J., McLaren, P. M., Summerfield, A.B., Watson, J. P, & Lipsedge, M. (1995). A comparison of communication modes in adult psychiatry. J Telemed Telecare, 1:22-26.

Behnke, S. (2008) Ethics in the age of the Internet. Monitor Psychology, 39(7):74.

Bishop, M., Yellowlees, P., Gates, C., & Silberman, G. (2011). Facebook goes to the doctor. In: ACM Press, pp.13-20.

Bisognano, M., Cherouny, P. H., & Gullo S. (2014). Applying a science-based method to improve perinatal care: the institute for healthcare improvement perinatal improvement community. Obstet Gynecol, 124(4):810-814.

Boyd, D. M., & Ellison, N. B. (2007). Social network sites: Definition, history, and scholarship. J Comput-Mediated Commun, 13(1):210–230.

Block, J. J. (2008). Issues for DSM-5: Internet addiction. Am J Psychiatry, 165(3):306-307.

British Medical Association. (2013). Using social media: practical and ethical guidance for doctors and medical students. At https://www.google.com/?gfe_rd=cr&ei=aPhbVc2PHc6xzQL4qoCwAw#q=british+medical+association+Using+social+media. Accessed June 30, 2015.

Byun, S., Ruffini, C., Mills, J. E., Douglas, A. C., Niang, M., Stepchenkova, S., Lee, S. K., … Blanton, M. (2009) Internet addiction: Metasynthesis of 1996-2006 quantitative research. Cyberpsychol Behav, 12(2):203-207.

Canadian Medical Association. (2015) Social media and Canadian physicians - issues and rules of engagement. At https://www.cma.ca/En/Pages/social-media-use.aspx. Accessed June 30, 2015.

Carli, V., Durkee, T. Pathological use of the Internet. In D. M. Mucic & D. M. Hilty (Eds.), Key Issues in e-Mental Health. New York, NY: Springer Publishing, In Press.

Carli, V., Durkee, T., Wasserman, D., Hadlaczky, G., Despalins, R., Kramarz, E., Wasserman, C., … & Kaess, M. (2013) The association between pathological internet use and comorbid psychopathology: A systematic review. Psychopathology, 46(1):1-13.

Chan, S. R., Torous, J. B., Hinton, W. L., & Yellowlees, P. M. Psychiatric apps: Patient self-assessment, communication, and potential treatment interventions. In D. M. Mucic & D. M. Hilty (Eds.), Key Issues in e-Mental Health. New York, NY: Springer Publishing, In Press.

Chretien, K.C., Greysen, S.R., Chretien, J.P., & Kind T. (2009). Online posting of unprofessional content by medical students. JAMA, 302:1309–1305.

Clinton, B. K., Silverman, B. C., & Brendel, D. H. (2010). Patient-targeted googling: the ethics of searching online for patient information. Harv Rev Psychiatry, 18(2):103-112.

Cole, J. I., Suman, M., Schramm, P., Zhou, L., & Salvador, A. (2013). The Digital Future Report. World Internet Project. Ed: Dunahee M, pp 181.

Council, L. S., Geffken D., Valeras A. B., Orzano, A. J., Rechisky, A., & Anderson, S. (2012). A medical home: Changing the way patients and teams relate through patient-centered care plans. Families Syst Health, 30:190–198.

Crabtree, B. F., Nutting, P. A., Miller, W. L., Stange, C. S., Stewart, E. E., & Jaen, C. R. (2010). Summary of the National Demonstration Project and recommendations for the patient-centered medical home. Ann Fam Med, 8(8)(Suppl 1):80-90.

Cukor, P., Baer, L., Willis, B. S., Leahy, L., O'Laughlen, J., Murphy, M., … & Martin, E. (1998). Use of videophones and low-cost standard telephone lines to provide a social presence in telepsychiatry. Telemed J, 4:313-321.

Davis, M. H., Everett, A., Kathol, R., Katon, W., McIntyre, J., Scully, J., Sitzer, L, & Sorel, E. (2011) American Psychiatric Association Ad Hoc Work Group Report on the Integration of Psychiatry and Primary Care. Available at: http://naapimha.org/wordpress/media/Integration-of-Psychiatry-and-Primary-Care.pdf. Accessed June 30, 2015.

DeJong, S. M., Benjamin, S., Anzia, J. M., John, N., Boland, R. J., Lomax, J., & Rostain, A. L. (2012). Professionalism and the internet in psychiatry: What to teach and how to teach it. Acad Psychiatr, 36(5):356-362.

Diagnostic and Statistical Manual, Fifth Edition (2013). Washington DC: American Psychiatric Publishing Incorporated.

Dossett, E. C., Shoemaker, E. Z., Nasatir-Hilty, S. E., Daly, J, & Hilty, D. M. (2015). Integrated care for women, mothers, children and newborns: Approaches and models for mental health, pediatric and prenatal care settings. J Women’s Health Care, 4:223, doi: 10.4172/2167-0420.1000223.

Durkee, T., Kaess, M., Carli, V, Parzer, P., Wasserman, C., Floderus, B., Apter, A., …. Wasserman, D. (2012). Prevalence of pathological internet use among adolescents in Europe: demographic and social factors. Addiction, 107(12):210-222.

Ekman, I., Swedberg, K., Taft, C., Lindseth, A., Norberg, A., Brink, E., (2011). Person-centered care—ready for prime time. Eur J Cardiovasc Nurs, 10(4):248–251.

Elford, R., White, H., Bowering, R., Ghandi, A., Maddiggan, B., St John, K., … Battcock, A. (2000). A randomized, controlled trial of child psychiatric assessments conducted using videoconferencing. J Telemed Telecare, 6:73-82.

Engel, G. L. (1980). The clinical application of the biopsychosocial model. Amer J Psychiatry, 137(5),535-544.

Facebook Newsroom. (2015). At http://newsroom.fb.com/company-info. Accessed June 30, 2015.

Farnan, J. M., Snyder Sulmasy, L., Worster, B. K.,Chaudhry, H. J., Rhyne, J. A., Arora, V. M., … & Federation of State Medical Boards Special Committee on Ethics and Professionalism. (2013). Online medical professionalism: patient and public relationships: policy statement from the American College of Physicians and the Federation of State Medical Boards. Ann Intern Med, 158(8):620-627.

Fisoun, V., Floros, G., Siomos, K., Geroukalis, D., & Navridis, K. (2012). Internet addiction as an important predictor in early detection of adolescent drug use experience—Implications for research and practice. J Addiction Med, 6(1):77-84.

Frankish, K., Ryan, C., & Harris, A. (2012). Psychiatry and online social media: potential, pitfalls and ethical guidelines for psychiatrists and trainees. Australas Psychiatry, 20:181-187.

Fussell, S. R., & Benimoff, N. I. (1995). Social and cognitive processes in interpersonal communication: Implications for advanced telecommunications technologies. Hum Factors, 37:228-250.

Gabbard, G. O., Kassaw, K. A., & Perez-Garcia, G. (2011). Professional boundaries in the era of the Internet. Acad Psychiatry, 35(3):168-174.

Ginory, A., Sabatier, L. M., & Eth, S. (2012). Addressing therapeutic boundaries in social networking. Psychiatry, 75(1):40-48.

Gong, J., Chen, X., Zeng, J., Li, F., Zhou, D., & Wang, Z. (2009). Adolescent addictive Internet use and drug abuse in Wuhan, China. Addiction Res Theory, 17(3):291-315.

Gorrindo, T., Groves, J. E. (2008) Web searching for information about physicians. JAMA, 9;300(2):213-215.

Grajales, F. J., Sheps, S., Ho, K., Novak-Lauscher, H., & Eysenbach, G. (2014). Social media: A review and tutorial of applications in medicine and health care. J Med Internet Res,16(2):e13.

Greenberg, M., Shergill, S., Szmukler, G., & Tantam, D. (2002). Narratives in Psychiatry. London, UK: Jessica Kingsley Publishing.

Greysen, S. R., Kind, T., & Chretien, K. C. (2010) Online professionalism and the mirror of social media. J Gen Intern Med, 25(11):1227-1229.

Gutheil, T. G., & Gabbard, G. O. (1993). The concept of boundaries in clinical practice: theoretical and risk-management dimensions. Am J Psychiatry, 150(2):188-196.

Hamann, J., Leucht, S., & Kissling, W. (2003). Shared decision making in psychiatry. Acta Psychiatrica Scandinavia, 107(6):403-409.

Harvard Business Review. (2013). How people really use mobile. Harvard Business Review,91(1):30-31.

Hidy, B., Porch, E., & Reed, S. (2013). Social networking and mental health. In Telemental Health, Eds Myers K, Turvey CL. Elsevier, New York, NY, pp. 367-395.

Hilty, D. M., Belitsky, R., Cohen, M. B., Cabaniss, D. L., Dickstein, L. J., Bernstein, C. A., Kaplan, A. S., … & Silberman, E. K. (2015). Impact of the information age residency training: The impact of the generation gap. Academic Psychiatry, 39(1):104-107.

Hilty, D. M., Ferrer, D., Callahan, E. J., & Yellowlees, P. M. (2013). The effectiveness of telemental health: A 2013 review. Tel J e-Health, 19(6):444-454.

Hilty, D. M., Luo, J. S., Morache, C., Marcelo, D. A., & Nesbitt, T. S. (2002). Telepsychiatry: An overview for psychiatrists. CNS Drugs, 16(8):527-548.

Hilty, D. M., Nesbitt, T. S., Kuenneth, C. A., Cruz, G. M., & Hales, R. E. (2002). How telepsychiatry affects the doctor-patient relationship: Communication, satisfaction, and additional clinically relevant issues. Primary Psychiatry, 9(9):29-34.

Hilty, D. M., Shoemaker, E. Z., Myers, K. M., Snowdy, C. E., Yellowlees, P. M., & Yager, J. Issues and steps toward a clinical guideline for telemental health for care of children and adolescents. J Child Adol Psychopharm, In Press.

Hilty, D. M., Srinivasan, M., Xiong, G., Ferranti, J., & Li, S. T. (2013). Lessons from psychiatry and psychiatric education for medical learners and teachers. International Rev Psychiatry,25:329-337.

Hilty, D. M., Ton, H., Lu, F., & Yager, J. (2014A). Educational reform: Engel’s biopsychosocial model for medical student education. Plenary, American Directors of Medical Student Education in Psychiatry, Keystone, CO.

Hilty, D. M., Ton, H., Lu, F., & Yager, J. (2014B). Revising Engel’s biopsychosocial model to the biopsychosocialcultural model? Suggestions and Implications. Workshop, American Directors of Medical Student Education in Psychiatry, Keystone, CO.

Hilty, D. M., & Yellowlees, P. M. (2015). Collaborative mental health services using multiple technologies – the new way to practice and a new standard of practice? J Amer Acad Child Adol Psychiatry, 54(4):245-246.

Hilty, D. M., Yellowlees, P. M., Chan, S., & Parish, M. B. Telepsychiatry: Effective, evidence-based and at a tipping point in healthcare delivery. Psych Clin N Amer, In Press.

Huang, R., Lu, Z., Liu, J., You, Y., Pan, Z., Wei, Z., He, Q., & Wang, Z. Z. (2009). Features and predictors of problematic internet use in Chinese college students. Behav Information Tech, 28(5):485-490.

Institute of Medicine.(2001). At http://www.iom.edu/~/media/Files/Report%20Files/2001/Crossing-the-Quality-Chasm/Quality%20Chasm%202001%20%20report%20brief.pdf. Accessed June 30, 2015.

Internet World Stats: Usage and Population Statistics, 2015. At: http://www.internetworldstats.com. Accessed June 30, 2015.

Jain, S. (2009). Practicing medicine in the age of Facebook. N Engl J Med, 361(7):649-651.

Johansson, A., & Gotestam, K. G. (2004). Internet addiction: Characteristics of a questionnaire and prevalence in Norwegian youth (12-18 years). Scand J Psychol, 45(3):223-229.

Kaess, M., Durkee, T., Brunner, R., Carli, V., Parzer, P., Wasserman, C., … & Wasserman, D. (2014). Pathological Internet use among European adolescents: psychopathology and self-destructive behaviours. Eur Child Adolesc Psychiatry, 1-10.

Kane, B., & Sands, D. Z. (1998). Guidelines for the clinical use of electronic mail with patients. J Am Med Inform Assoc, 5(1):104-111.

Kheirkhah, F., Juibary, A. G., & Gouran, A. (2010). Internet addiction, prevalence and epidemiological features in Mazandaran Province, Northern Iran. Iran Red Crescent Med J, 12(2):133.

Kim, T., & Biocca, F. (2015). Telepresence via television: Two dimensions of telepresence may have different connections to memory and persuasion. J Computer-Mediated Commun 1997;3: NP. At http://www.mindlab.org/images/d/DOC810.pdf. Accessed June 30, 2015.

Koh, S., Cattell, G. M., Cochran, D. M., Krasner, A., Langheim, F. J., & Sasso, D. A. (2013) Psychiatrists' use of electronic communication and social media and a proposed framework for future guidelines. J Psychiatr Pract, 19(3):254-263.

Kuss, D. J., Griffiths, M. D., Karila, L., & Billieux, J. (2013). Internet addiction: A systematic review of epidemiological research for the last decade. Curr Pharm Des 20, 4026-4052.

Lam, L. T., & Wong, E. M. (2015). Stress moderates the relationship between problematic Internet use by parents and problematic Internet use by adolescents. J Adolesc Health, 56(3):300-306.

Leung, L. (2004). Net-generation attributes and seductive properties of the Internet as predictors of online activities and internet addiction. Cyberpsychol Behav, 7(3):333-348.

Li, Y., Zhang, X., Lu, F., Zhang, Q., & Wang, Y. (2014). Internet addiction among elementary and middle school students in China: A Nationally Representative Sample Study. Cyberpsychology Behav Soc Networking, 17(2):111-116.

Lin, C. H., Lin, S. L., & Wu, C. P. (2009). The effects of parental monitoring and leisure boredom on adolescents' Internet addiction. Adolescence, 44(176):993-1004.

MacDonald, J., Sohn, S., & Ellis, P. (2010). Privacy, professionalism and Facebook: A dilemma for young doctors. Med Educ, 44(8):805-813.

Miles, A., & Mezzich, J. (2011). The care of the patient and the soul of the clinic: Person-centered medicine as an emergent model of modern clinical practice. Int J Pers Centered Med, 1(2):207–222.

Mitchell, K. J., & Ybarra, M. (2009). Social networking sites: finding a balance between their risks and benefits. Arch Pediatr Adolesc Med, 163(1):87-89.

Moubarak, G., Guiot, A., Benhamou, Y., Benhamou, A., & Hariri, S. (2011). Facebook activity of residents and fellows and its impact on the doctor-patient relationship. J Med Ethics, 37(2):101-104.

Mucic, D., Hilty, D. M., Parish, M. B., & Yellowlees, P. M. Web- and Internet-based services: Education, support, self-care and formal treatment approaches. In D. M. Mucic & D. M. Hilty (Eds.), Key Issues in e-Mental Health. New York, NY: Springer Publishing, In Press.

Myers, K. M., & Lieberman, D. (2013). Telemental health: Responding to mandates for reform in primary healthcare. Telemed J E Health, 19(6):438-443.

Myers, K. M., Vander Stoep, A., Zhou, C., McCarty, C. A., & Katon, W. (2015). Effectiveness of a telehealth service delivery model for treating attention-deficit hyperactivity disorder: Results of a community-based randomized controlled trial. J Amer Asso Child Adol Psych, 54(4):263-274.

O'Malley, C., Langston, S., & Anderson, A. (1996). Comparison of face-to-face and video-mediated interaction. Interacting Computers, 8:177-192.

Ochsman, R. B., & Chapanis, A. (1974). The effects of 10 communication modes on the behavior of teams during co-operative problem-solving. Int J Man-Machine Studies, 6:579-619.

Odor, A., Yellowlees, P., Hilty, D., Parish, M. B., Nafiz, N., Iosif, A. M. (2011). PsychVACS: A system for asynchronous telepsychiatry. J Tel e-Health, 17(4):299-303.

Rosenthal, T. C. (2008). The medical home: growing evidence to support a new approach to primary care. J Am Board Fam Med, 21(5):427-440.

Rutter, D. R. (1984). Looking and Seeing: The Role of Visual Communication in Social Interaction. Chichester, West Sussex, UK: Wiley Publishing.

PEW Research Center Internet Survey. (2013). At: http://www.pewinternet.org/~/media//Files/Reports/PIP_HealthOnline.pdf or smart phone information. Or at: http://www.pewinternet.org/data-trend/mobile/cell-phone-and-smartphone-ownership-demographics/. Accessed June 30, 2015.

Silk, K. R., & Yager, J. (2003). Suggested guidelines for E-mail communication in psychiatric practice. J Clin Psychiatry, 64:7.

Shaw, M., & Black, D. W. (2008). Internet addiction: Definition, assessment, epidemiology and clinical management. CNS Drugs, 22(5):353-365.

Shore, R., Halsey, J., Shah, K., Crigger, B. J., Douglas, S. P., & AMA Council on Ethical and Judicial Affairs (CEJA). (2011). Report of the AMA Council on Ethical and Judicial Affairs: Professionalism in the Use of Social Media. J Clin Ethics, 22(2):165-172.

Shore, J. H., Mishkind, M. C., Bernard, J., Doarn, C. R., Bell, I. Jr, Bhatla, R., ... & Vo, A. (2013). A lexicon of assessment and outcome measures for telemental health. Tel e-Health,3:282-292.

Siomos, K., Floros, G., Fisoun, V., Evaggelia, D., Farkonas, N., Sergentani, E., Lamprou, M., Geroukalis, D. (2012). Evolution of Internet addiction in Greek adolescent students over a two-year period: the impact of parental bonding. Eur Child Adolesc Psychiatry, 21(4):211-219.

Siomos, K. E., Dafouli, E. D., Braimiotis, D. A., Mouzas, O. D., & Angelopoulos, N. V. (2008). Internet addiction among Greek adolescent students. Cyberpsychol Behav, 11(6):653-657.

Snowdy, C., Shoemaker, E. Z., & Hilty, D. M. Social Media and Clinical Practice: What Stays the Same, What Changes and How To Plan Ahead? In D. M. Mucic & D. M. Hilty (Eds.), Key Issues in e-Mental Health. New York, NY: Springer Publishing, In Press.

Thompson, L. A., Dawson, K., Ferdig, R., Black, E. W., Boyer, J., Coutts, J., & Black, N. P. (2008). The intersection of online social networking with medical professionalism. J Gen Intern Med, 23:954–957.

Tsivos, Z. L., Calam, R., Sanders, M. R., & Wittkowski, A. (2014). A pilot randomized controlled trial to evaluate the feasibility and acceptability of the Baby Triple P Positive Parenting Programme in mothers with postnatal depression Clin Child Psychol Psychiatry, 1-23.

Turner, J. W. (2001). Telepsychiatry as a case study of presence: Do you know what you are missing? J Computer-Mediated Commun, 6(4). DOI: 10.1111/j.1083-6101.2001.tb00132.x

Wang, L., Luo, J., Bai, Y., Kong, J., Luo, J., Gao, W., 7 Sun, X. (2103) Internet addiction of adolescents in China: Prevalence, predictors, and association with well-being. Addiction Res Theory, 21(1):62-69.

Yellowlees, P., & Nafiz, N. (2010). The psychiatrist-patient relationship of the future: Anytime, anywhere? Harv Rev Psychiatry, 18(2):96-102.

Yellowlees, P. M., Odor, A., Iosif, A., Parish, M. B., Nafiz, N., Patrice, K., …& Hilty, D.M. (2013). Transcultural psychiatry made simple: Asynchronous telepsychiatry as an approach to providing culturally relevant care. Tel e-Health, 19(4):1-6.

Yellowlees, P. M., Shore, J. H., Roberts, L., & American Telemedicine Association. (2010). Practice Guidelines for Videoconferencing-Based Telemental Health. Tel e-Health, 16(10):1074-1089.

Young, K. (1998). Internet addiction: The emergence of a new clinical disorder. Cyberpsychology Behav, 1(3):237-244.

Young, K. (2008). Assessment of Internet addiction. At: http://www.globaladdiction.org/dldocs/GLOBALADDICTION-Scales-InternetAddictionTest.pdf. Accessed June 30, 2015.